Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 289234 | NY |
NPI | 1043502933 |
---|---|
Provider Name | Michael Justin Persky |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-4744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 19/09/2017 |